Acute care delivery systems are in a state of crisis. Financial constraints imposed by health care reform have caused many hospitals to reorganize services and downsize staff. Much of this redesign has been done without benefit of empirical testing. The purpose of this research is to test alternative organization theories Perrow's framework for organizational analysis, structural contingency theory, and sociotechnical systems theory for best fit with quality patient and organization outcomes. Five patient outcomes, failure to rescue, complications, mortality, patient falls, medication administration errors and one organizational outcome, cost per case mix adjusted adjusted discharge will be measured. An ex post facto cross-sectional quantitative research design will be used to understand the relationships among the phenomena of interest. Causal modeling will be used to test for causation among the model variables.